Long-Term Detection of Propofol Glucuronide in Urine Following Anesthetic Induction and Maintenance with Propofol

DOI: 10.4236/pp.2013.47076   PDF   HTML     6,165 Downloads   8,615 Views   Citations


Propofol is the most commonly used compound for the intravenous induction and maintenance of anesthesia. Propofol addiction and abuse have become causes for concern in the healthcare community, especially among anesthesia and surgical professionals. The US Drug Enforcement Administration does not list propofol on any Schedules and most hospitals do not have inventory controls in place to prevent its misuse. Propofol is detectable in blood plasma as the parent compound for as much as 15 hours post-anesthesia. The metabolite propofol glucuronide (PPFG) has been detected in blood and urine as far out as 60 hours. Here we report the long-term renal excretion of PPFG in specimens from A) four participants following a 14-day course of orally ingested propofol dosing, and B) a female patient following anesthetic induction and 15 minutes’ maintenance with propofol. Urinary PPFG was measurable well above limits of quantitation up to 6 days following oral ingestion and 28 days post-anesthesia. We also present a third set of data evaluating the likelihood of passive exposure to aerosolized propofol in the surgical environment by analyzing the levels of urinary PPFG of healthcare workers following operating room work shifts. The results presented here demonstrate that quantitation of PPFG in urinary samples is an efficient method of long-term screening for propofol misuse and abuse.

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J. Salerno, J. Jones, M. Jones, C. Plate and D. Lewis, "Long-Term Detection of Propofol Glucuronide in Urine Following Anesthetic Induction and Maintenance with Propofol," Pharmacology & Pharmacy, Vol. 4 No. 7, 2013, pp. 528-534. doi: 10.4236/pp.2013.47076.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] C. M. Smith and A. M. Reynard, “Textbook of Pharmacology,” Harcourt Publishers Ltd., San Diego, 1992.
[2] A. Gupta, T. Stierer, R. Zuckerman, N. Sakima, S. D. Parker and L. A. Fleisher, “Comparison of Recovery Profile after Ambulatory Anesthesia with Propofol, Isoflurane, Sevoflurane and Desflurane: A Systematic Review,” Anesthesia & Analgesia, Vol. 98, No. 3, 2004, pp. 632-641.
[3] E. I. Eger, “Characteristics of Anesthetic Agents Used for Induction and Maintenance of General Anesthesia,” American Journal of Health-System Pharmacy, Vol. 61, Suppl. 4, 2004, pp. S3-S10.
[4] B. Fulton and E. M. Sorkin, “Propofol. An Overview of Its Pharmacology and a Review of Its Clinical Efficacy in Intensive Care Sedation,” Drugs, Vol. 50, No. 4, 1995, pp. 636-657.
[5] J. Kanto and E. Gepts, “Pharmacokinetic Implications of the Clinical Use of Propofol,” Clinical Pharmacokinetics, Vol. 17, No. 5, 1989, pp. 308-326. http://dx.doi.org/10.2165/00003088-198917050-00002
[6] P. E. Wischmeyer, B. R. Johnson, J. E. Wilson, C. Dingmann, H. M. Bachman, E. Roller, Z. V. Tran and T. K. Henthorn, “A Survey of Propofol Abuse in Academic Anesthesia Programs,” Anesthesia & Analgesia, Vol. 105, No. 4, 2007, pp. 1066-1071. http://dx.doi.org/10.1213/01.ane.0000270215.86253.30
[7] C. F. Ward, “Propofol: Dancing with the ‘White Rabbit’,” Bulletin of the California Society of Anesthesiology, Vol. 57, No. 2, 2008, pp. 61-63.
[8] C. Bleeker, T. Vree, A. Lagerwerf, and E. Williams-van Bree, “Recovery and Long-Term Renal Excretion of Propofol, Its Glucuronide, and Two Di-Isopropylquinol Glucuronides after Propofol Infusion during Surgery,” British Journal of Anaesthesia, Vol. 101, No. 2, 2008, pp. 207-212. http://dx.doi.org/10.1093/bja/aen134
[9] P. Favetta, C. S. Degoute, J. P. Perdrix, C. Dufresne, R. Boulieu and J. Guitton, “Propofol Metabolites in Man Following Propofol Induction and Maintenance,” British Journal of Anaesthesia, Vol. 88, No. 5, 2008, pp. 653-658. http://dx.doi.org/10.1093/bja/88.5.653
[10] O. H. Drummer, “A Fatality Due to Propofol Poisoning,” Journal of Forensic Science, Vol. 37, No. 4, 1992, pp. 1186-1189.
[11] T. C. Chao, D. S. Lo, P. P. Chui and T. H. Koh, “The First Fatal 2, 6-Di-Isopropylphenol (Propofol) Poisoning in Singapore: A Case Report,” Forensic Science International, Vol. 66, No. 1, 1994, pp. 1-7. http://dx.doi.org/10.1016/0379-0738(94)90314-X
[12] S. Iwersen-Bergmann, P. Rosner, H. C. Kuhnau, M. Junge and A. Schmoldt, “Death after Excessive Propofol Abuse,” International Journal of Legal Medicine, Vol. 114, No. 4-5, 2001, pp. 248-251. http://dx.doi.org/10.1007/s004149900129
[13] E. F. Kranioti, A. Mavroforou, P. Mylonakis and M. Michalodimitrakis, “Lethal Self Administration of Propofol (Diprivan). A Case Report and Review of the Literature,” Forensic Science International, Vol. 167, No. 1, 2007, pp. 56-58. http://dx.doi.org/10.1016/j.forsciint.2005.12.027
[14] G. Klausz, K. Rona, I. Kristof and K. Toro, “Evaluation of a Fatal Propofol Intoxication Due to Self Administration,” Journal of Forensic and Legal Medicine, Vol. 16, No. 5, 2009, pp. 287-289. http://dx.doi.org/10.1016/j.jflm.2008.12.010
[15] H. M. Bryson, B. R. Fulton and D. Faulds, “Propofol. An Update of Its Use in Anesthesia and Conscious Sedation,” Drugs, Vol. 50, No. 3, 1995, pp. 513-559. http://dx.doi.org/10.2165/00003495-199550030-00008
[16] W. R. Needleman, M. Porvaznik and D. Ander, “Creatinine Analysis in Single Collection Urine Specimens,” Journal of Forensic Sciences, Vol. 37, No. 4, 1992, pp. 1125-1133.
[17] “DRI® Creatinine-Detect Test,” Product Insert, Microgenics Corporation, Fremont, 2005.
[18] O. Grundmann, “Propofol: An Analytical and MedicoLegal Challenge,” Forensic Magazine, Vol. 7, No. 5, 2010, pp. 13-15.
[19] J. P. Zacny, J. L. Lichtor, W. Thompson and J. L. Apfelbaum, “Propofol at a Subanesthetic Dose May Have Abuse Potential in Healthy Volunteers,” Anesthesia and Analgesia, Vol. 77, No. 3, 1993, pp. 544-552. http://dx.doi.org/10.1213/00000539-199309000-00020
[20] U. Bonnet, J. Harkener and N. Scherbaum, “A Case Report of Propofol Dependence in a Physician,” Journal of Psychoactive Drugs, Vol. 40, No. 2, 2008, pp. 215-217.
[21] P. F. McAuliffe, M. S. Gold, L. Baipai, M. L. Merves, K. Frost-Pineda, R. M. Pomm, B. A. Goldberger, R. J. Melker and J. C. Cendan, “Second-Hand Exposure to Aerosolized Intravenous Anesthetics Propofol and Fentanyl May Cause Sensitization and Subsequent Opiate Addiction among Anesthesiologists and Surgeons,” Medical Hypotheses, Vol. 66, No. 5, 2006, pp. 874-882.
[22] L. J. Merlo, B. A. Goldberger, D. Kolodner, K. Fitzgerald and M. S. Gold, “Fentanyl and Propofol Exposure in the Operating Room: Sensitization Hypotheses and Further Data,” Journal of Addictive Disorders, Vol. 27, No. 3, 2008, pp. 67-76. http://dx.doi.org/10.1080/10550880802122661
[23] P. H. Earley and T. Finver, “Addiction to Propofol: A Study of 22 Treatment Cases,” Journal of Addiction Medicine, Vol. 7, No. 3, 2013, pp. 169-176. http://dx.doi.org/10.1097/ADM.0b013e3182872901
[24] V. Cirimele, P. Kintz, S. Doray and B. Ludes, “Determination of Chronic Abuse of the Anesthetic Agents Midazolam and Propofol as Demonstrated by Hair Analysis,” International Journal of Legal Medicine, Vol. 116, No. 1, 2002, pp. 54-57. http://dx.doi.org/10.1007/s004140100240

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